Medicare Plan Lookup Official CMS data · Contract Year 2027
CMS 2027 data

2027 Medicare plan code

H1889-005

Medicare Plan

UHC Dual Complete NC-Q1 (PPO D-SNP) · UnitedHealthcare · Local PPO · State of North Carolina

Full CMS plan ID: H1889-005-000

H1889-005-000 is the full CMS identifier for the H1889-005 Medicare plan. Common searches include H1889 005 and H1889005.

2027

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2027 plan record

UHC Dual Complete NC-Q1 (PPO D-SNP)

H1889-005-000 State of North Carolina Local PPO Dual-Eligible

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $2,075 per stay
Out-of-network

Tier 1: $2,075 per stay

Point of service

Not separately reported

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

$115 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$9,850
Combined in + out$14,800
05

Skilled care at home

Home health

In-network$0 copay
Out-of-network$0 copay
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

CMS reports no Part B premium reduction for this plan.

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkPrimary Care Physician Services: 0%–20% coinsurance
Out-of-network7a: 30% coinsurance

Specialist

In-networkPhysician Specialist Services: 0%–20% coinsurance
Out-of-network7d: 30% coinsurance

Preventive care

In-networkAnnual Physical Exam: $0 copay; Kidney Disease Education Services: $0 copay; Glaucoma Screening: $0 copay; Diabetes Self-Management Training: $0 copay; Digital Rectal Exams: 20% coinsurance; EKG following Welcome Visit: 20% coinsurance
Out-of-network14b: 40% coinsurance; 14d: 40% coinsurance; 14e1: 40% coinsurance; 14e2: 40% coinsurance; 14e4: 40% coinsurance; 14e5: 40% coinsurance; 14a: 0%–40% coinsurance
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkDiagnostic Procedures/Tests: 20% coinsurance
Out-of-network8a1: 40% coinsurance

Laboratory services

In-networkLab Services: $0 copay
Out-of-network8a2: $0 copay

X-rays & standard imaging

In-networkOutpatient X-Ray Services: 20% coinsurance
Out-of-network8b3: 40% coinsurance

MRI, CT & PET imaging

In-networkDiagnostic Radiological Services: 0%–20% coinsurance
Out-of-network8b1: 40% coinsurance
Urgent & hospital care6 benefits

Urgent care

In-networkUrgently Needed Services: $0–$40 copay
Out-of-networkNot separately reported

Emergency room

In-network$115 copay
Out-of-networkNot separately reported

Ground ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Air ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Outpatient hospital

In-networkOutpatient Hospital Services: 0%–20% coinsurance; Observation Services: 20% coinsurance
Out-of-network9a1: 40% coinsurance; 9a2: 40% coinsurance

Outpatient surgery / ASC

In-networkAmbulatory Surgical Center (ASC) Services: 0%–20% coinsurance
Out-of-network9b: 40% coinsurance
Recovery & therapy5 benefits

Home health

In-network$0 copay
Out-of-network$0 copay

Skilled nursing facility

In-networkSkilled nursing facility: Tier 1: Medicare-defined copayment cost sharing applies (in-network, tier 1).
Out-of-networkSkilled nursing facility: Verify in plan documents

Cardiac & pulmonary rehabilitation

In-networkCardiac Rehabilitation Services: 20% coinsurance; Intensive Cardiac Rehabilitation Services: 20% coinsurance; Pulmonary Rehabilitation Services: 20% coinsurance; SET for PAD Services: 20% coinsurance; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-network3-1: 30% coinsurance; 3-2: 30% coinsurance; 3-3: 30% coinsurance; 3-4: 30% coinsurance

Occupational therapy

In-networkOccupational Therapy Services: 20% coinsurance
Out-of-network7c: 30% coinsurance

Physical & speech therapy

In-networkPhysical Therapy and Speech-Language Pathology Services: 20% coinsurance
Out-of-network7i: 30% coinsurance
Behavioral health2 benefits

Mental health services

In-networkPartial Hospitalization Program: $55 copay; Individual Sessions for Mental Health Specialty Services: 0%–20% coinsurance; Group Sessions for Mental Health Specialty Services: 20% coinsurance; Individual Sessions for Psychiatric Services: 0%–20% coinsurance; Group Sessions for Psychiatric Services: 20% coinsurance; Inpatient psychiatric hospital: Tier 1: $2,075 per stay
Out-of-network5a: 30% coinsurance; 7e1: 30% coinsurance; 7e2: 30% coinsurance; 7h1: 30% coinsurance; 7h2: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: $2,075 per stay

Substance use treatment

In-networkIntensive Outpatient Program Services: $55 copay; Individual Sessions for Outpatient Substance Abuse: 0%–20% coinsurance; Group Sessions for Outpatient Substance Abuse: 20% coinsurance
Out-of-network5b: 30% coinsurance; 9c1: 30% coinsurance; 9c2: 30% coinsurance
Specialty care2 benefits

Podiatry

In-networkPodiatry Services: 20% coinsurance; 7f(NMC): $0 copay
Out-of-network7f: 30% coinsurance; 7f_2: 30% coinsurance

Chiropractic

In-networkChiropractic Services: 20% coinsurance
Out-of-network7b: 30% coinsurance
Supplemental benefits7 benefits

Dental

In-networkMedicare Dental Services: 20% coinsurance; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Other Diagnostic Dental Services: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Other Preventive Dental Services: $0 copay; Restorative Services: $0 copay; Endodontics: $0 copay; Periodontics: $0 copay; Prosthodontics, removable: $0 copay; Maxillofacial Prosthetics: $0 copay; Prosthodontics, fixed: $0 copay; Oral and Maxillofacial Surgery: $0 copay; Adjunctive General Services: $0 copay
Out-of-network16a: 40% coinsurance; 16b1: $0 copay; 16b2: $0 copay; 16b3: $0 copay; 16b4: $0 copay; 16b5: $0 copay; 16b6: $0 copay; 16c1: $0 copay; 16c2: $0 copay; 16c3: $0 copay; 16c4: $0 copay; 16c5: $0 copay; 16c7: $0 copay; 16c8: $0 copay; 16c10: $0 copay

Vision

In-networkEye Exams: $0 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
Out-of-network17a: 30% coinsurance; 17a1: 30% coinsurance; 17b: 40% coinsurance; 17b1: 90% coinsurance; 17b2: 90% coinsurance

Hearing

In-networkHearing Exams: 20% coinsurance; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: Not applicable; Prescription Hearing Aids (all types): $0 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-network18a: 30% coinsurance; 18a1: 30% coinsurance; 18b1: 90% coinsurance

Transportation

In-network10b(NMC): $0 copay
Out-of-networkNot separately reported

Fitness & wellness

In-networkFitness Benefit: $0 copay
Out-of-network14c4: 90% coinsurance

Over-the-counter allowance

In-networkOver-the-Counter (OTC) Items: $0 copay
Out-of-network13b: 90% coinsurance

Meals

Not applicable
In-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · CMS reports no Part B premium reduction for this plan.

Maximum out-of-pocket (MOOP)

In-network$9,850
Combined in + out$14,800

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Annual health deductible

Not separately reported

Combined network deductible

Not separately reported

Part D premium

$0 / month

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs5 tiers

Part D deductible

$700 / year

Drug tier 1

Standard retail: $0 copay · Preferred retail: $0 copay · 30-day supply

Drug tier 2

Standard retail: $4 copay · Preferred retail: $4 copay · 30-day supply

Drug tier 3

Standard retail: 25% coinsurance · Preferred retail: 25% coinsurance · 30-day supply

Drug tier 4

Standard retail: 25% coinsurance · Preferred retail: 25% coinsurance · 30-day supply

Drug tier 5

Standard retail: 25% coinsurance · Preferred retail: 25% coinsurance · 30-day supply

Using this plan

Understand H1889-005-000

Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

UHC Dual Complete NC-Q1 (PPO D-SNP) is a 2027 Local PPO offered by UnitedHealthcare in State of North Carolina. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Primary Care Physician Services: 0%–20% coinsurance
Specialist
Physician Specialist Services: 0%–20% coinsurance
Laboratory services
Lab Services: $0 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Diagnostic Procedures/Tests: 20% coinsurance
MRI, CT & PET imaging
Diagnostic Radiological Services: 0%–20% coinsurance
Outpatient hospital
Outpatient Hospital Services: 0%–20% coinsurance; Observation Services: 20% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$115 copay

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Part B premium reduction (“giveback”)

A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports no Part B premium reduction for this plan.

Availability

Who can enroll

Service area
State of North Carolina (NC)
Plan type
Local PPO
Special Needs Plan
Dual-Eligible
Contract / plan
H1889-005
Coverage year
2027

This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalMedicare Dental Services: 20% coinsurance; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Other Diagnostic Dental Services: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Other Preventive Dental Services: $0 copay; Restorative Services: $0 copay; Endodontics: $0 copay; Periodontics: $0 copay; Prosthodontics, removable: $0 copay; Maxillofacial Prosthetics: $0 copay; Prosthodontics, fixed: $0 copay; Oral and Maxillofacial Surgery: $0 copay; Adjunctive General Services: $0 copay
VisionEye Exams: $0 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
HearingHearing Exams: 20% coinsurance; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: Not applicable; Prescription Hearing Aids (all types): $0 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Over-the-counter allowanceOver-the-Counter (OTC) Items: $0 copay
Fitness & wellnessFitness Benefit: $0 copay
Transportation10b(NMC): $0 copay

Plan-specific answers

Frequently asked questions

Where is H1889-005-000 available?

UHC Dual Complete NC-Q1 (PPO D-SNP) is listed for State of North Carolina (NC). This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H1889-005-000?

The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $9,850. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H1889-005-000?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H1889-005-000?

The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.

Does H1889-005-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2027

Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H1889-005-000 fits

Full CMS plan ID
H1889-005-000
Contract
H1889
Base plan code
H1889-005
Segment
000
Carrier
UnitedHealthcare
Plan type
Local PPO
Service area
State of North Carolina (NC)

County/service-area foundation

CMS service-area entries

Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.

  • Alamance, NC
  • Alexander, NC
  • Alleghany, NC
  • Anson, NC
  • Ashe, NC
  • Avery, NC
  • Beaufort, NC
  • Bertie, NC
  • Bladen, NC
  • Brunswick, NC
  • Buncombe, NC
  • Burke, NC

88 additional service-area entries are retained in the data record.

Exact county navigation

These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.

Show 100 county links
North Carolina

Same CMS contract

H1889-034-000 UHC Dual Complete NC-S2 (PPO D-SNP) State of North Carolina · Local PPO H1889-801-000 UnitedHealthcare Group Medicare Advantage (PPO) Select Counties · Local PPO H1889-002-001 UHC Dual Complete FL-Q1 (PPO D-SNP) Northern Florida · Local PPO H1889-002-002 UHC Dual Complete FL-Q1 (PPO D-SNP) Southern Florida · Local PPO H1889-007-000 UHC Dual Complete PA-S001 (PPO D-SNP) State of Pennsylvania · Local PPO H1889-008-000 UHC Dual Complete KY-Q1 (PPO D-SNP) Select Counties in Kentucky · Local PPO H1889-009-000 UHC Dual Complete AL-Q2 (PPO D-SNP) Select Counties of Alabama · Local PPO H1889-010-000 UHC Dual Complete LA-Q1 (PPO D-SNP) State of Louisiana · Local PPO

About this code

What H1889-005-000 identifies

H1889-005-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H1889-005, H1889 005, or the compact full CMS ID H1889005000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.